S ployees -- -......................................................... ........................
..-... IIf. Causes of deaths of employees arranged with reference to color,
.. age, and length of residence on Isthmus...............................
': :. Deaths of residents and death rates, of the Canal Zone and the
cities of Panam a and Colon.....................................................
IV. Deaths of residents of the Canal Zone and the cities of Panama and
Colon, by cause, sex, color, age, and place of residence ..........
; 7:. V. Deaths of nonresidents, by cause, sex, color, and age. ..................
VI. Statistics regarding American employees and their families ...........
S VII. Births and birth rates in the Canal Zone and the cities of Panama
and C olon ......... ........ ........................ ..................
II, .Infant mortality rates in the Canal Zone and the cities of Panama
and C olon......... ........... .... ..... ..................
::;iX Discharge and deaths in hospitals of The Panama Canal...
I 2.:;".' Consolidated hospital and asylum report...... ........... .....................
S 1"-. :Numuber of days hospital treatment furnished various classes of
patients and average number in hospital each day ...............
I & port of dispensaries... ... ............. .........................................
Ij slidated admission report, hospitals and dispensaries..............
F IZ C itozal Hospital, statement of commitments and discharges..........
c port ..... ------------ ......................................................................
|:. ..... .. .... .... ,.
3

SIR: I have the honor to submit the following report of the operPt
tions of the Health Department for the calendar year 1925.i
Respectfully,
W. P. CHAMBERLAIN ,' .
Chief Health Offiei.:,

i T.
: ..,1

A'
... : 1::]) 1
4 ": N .

i ".ME. i!X
.... ..t...

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..... ....
U ; HEALTH DEPARTMENT.

OPERATION AND ORGANIZATION.

i ? operation and' organization of the Health' Department is the
Sl ias described .in the .report for the calendar year 1923, with the
jl -that Santo Tomas Hospital, in the city of Panama, R. P.,
eiA|pedj to be under the jurisdiction of the Health Department, Sep-
er 1,4924.
Sc PERSONNEL. ,

The:.;! funds for" the operation of the Health Department are derived
lfm a specific appropriation made annually by Congress and
'fy fro6 the earnings of the department, which at present slightly
the apprtopriation. The. accounts "of The Panama Canal are
by fisc years and thf figures shown at top of next page are a
ry for the fiscal year ending June 30,1925:

SUMMARY OF VITAL STATISTICS' REGARDING i- .
EMPLOYEES ONLY*
The admission rate to hospitals and quarters, from all coitttsig
has been as shown in Chart No. 1 at top of opposite page: .
*All rates throughout this report are computed as annual pe .i r, r
Includes all employees of The Panama Canal and the Panamsa aioad on the latfinusi thhtd ng!
in the Canal Zone. and cities of Colon and Panama. e.
Active sanitary work in the Canal Zone and in the cities of Colon aqd Panama tw*n ft1eti
by the United States soon after the control of the proper y F th ftncb CaNlt COlOs'"
taken over in May, 1904. Tables are therefore carried as ftir bak toward that date as figures. i i
available. to give a comparison of the results of work done silne.;

:- The ttl admission rate to hospitalswas 60.8 in 1925, as compared
S rate to hospitals in 1925 was 140.64, as compared with 130.32406

S' 24, and 133.48 in 1923.

g; 'The death rate, from all causes, has been as follows:
rIW8 _________- 905
S12 1 14,389CHART O. 2.

AAM.age
922 10,447 4490
.923 10,976 485

)43,890 13.01
9 48,87625 11.02
19'2 50,893 59.18

2 56,754 8.35
1 ,785 5.37
-192512,189 51.09
The total admission rate to hospitals-was 160.84 in 1925, as compared
..itb 151.57- in 1924, and 155.90 in 1923. From disease alone the
aM'ilssion rate to hospitals in 1925 was 140.64, as compared with 130.32
w aa -1924, and 133.48 in 1923.
The death rate, from all causes, has been as follows:

The admission rate to hospitals from disease, and death rate i
disease, for white employees, were 206.85 a'nd 2.88, respectively.. t:..
compared with 117.81 and 9.39 for black employees.
The death rate from disease for American (white) implo4ees
2.57, as compared with 4.14 for 1924( and 4.87 for 1923.
134 of these admissions were from Bruja Point, where a gang of men was doing construction work ii atempn*i
camp, three miles beyond our sanitated areas. The rate, excepting these cases, is 16.09

I IMARY OF VITAL STATISTICS FOR THE CANAL ZONE-
EMPLOYEES AND NONEMPLOYEES.

ro aaaverage population of 34,840 in the Canal Zone, there were
Sid. eaths during the year; 241t of these were from disease, giving a
jiiate: f6.92, ias compared with 8.01 for 1924, and 7.14 for 1923.
S Aemii tefrorrltuberculgnis was 0.89, as compared with 1.01 for
9 .S9 4.9 9 fir :1923, 0.74 for 1922, and 0.64 for 1921. Tuberculosis
cu!e:ii' 13 per cent of all deaths from disease during the year, as com-
.. wedwt. 1t3:percent.in 924, 0-per cent in 1923, 10 per cent in 1922,
S:.$d per cent in 1921.
*::':Th.ere were 616 live births reported during the year, giving a birth
r"at ..of 17.68.. (See Table VII, page 51). Of these, 193 were white,
: and 423 were black. Of the total births reported, 5 per cent were
stillbirths.
S" Deaths among children under 1 year of age, from all causes, totaled
48,oftwhich 7 were white and 41 were black, giving an infant mortality
.:r rate, bas6d on the number of live births reported during the year, of
36.27 for white children, 96.93 for black children, and a general average
of 77.92.
Of the total deaths for all ages, 16 per cent occurred among children
mder I yeaIof age, and 27 percent among children under 5 years of age.

S'he death rate from tuberculosis was 2.01, as compared with 2.62
for 1924, 1.92 for 1923, 2.55 for 1922, and 2.30 for 1921. Tuberculosis
i..- sieAplunir lately 17 per cent of all deaths from disease, as com-
: pared with'18 per cent in 1924, 15 per cent in 1923, 19 per cent in 1922,
Sand 13 per cent in.1921.
'There were 769 live births reported during the year, giving a birth
rate f 24.58. Of the total births reported, 4 per cent Were stillbirths.
:There were 90 deaths among children under 1 year of age, giving an
: infant mortality rate, based on the number of live births reported dur-
: -ing'the year, of 117.04.
;. Of the total deaths for all ages, 23 per cent occurred among children
':. under year of age, and 31 per cent among children under 5 yzars of age.
SBelow is a chart showing the death rates in Colon from 1905 to 1925,
From all causes:RT N. 6.
CHART NO. 6.

Excluding the 134 cases from Bruja Point, the admission rate f om *.
malaria was 24.66 for white employees and 13.14 for black envploy ...,
(See page 16.)
There were no deaths from malaria"among employees .durgi.ng 't
year, 1925.
The death rates from malaria among employees. from i906t:,to 16M.
are shown in Chart No. 8 at top of opposite page:

mosquito situation.-There are about 135 species of mosquitos on
.: the Isthmus, but most of them breed and spend their lives in the jungle,
tzrely, if ever, attacking man. Only a few species are of sanitary or
.-:eco rimic importance and these, for the purpose of mosquito control,
i-may conveniently be divided into three general classes.
(a) Mosqui(pes which transmit malaria, viz., anopheles of a few species. On the
SIsthimus the principal offenders are A. albimanus and A. tarsimaculata. These two
.. species breed in natural collections of water, pools, streams, ponds, etc., and under
it:'favorable'conditions fly to and enter houses at distances as great as a mile or more
I:. from their place of origin. They bite at night or near dusk, rarely by day except
iii i.ey deep shade.
bi:. .( Mosquitoes which transmit yellow fever and probably dengue fever, viz., Aedes
pi: lgyti, formerly designated as Stegomyia fasciala. A. aegyptiis essentially a domestic
O;.ldquiqto; laying its eggs in artificial collections of clean water provided by receptacles
:.such as, cisterns, jars, bottles, tin cans, sagging gutters, ant guards, vases, unused
P e. tpg ;s, etc 'These mosquitoes for the most part breed in the house or yard and
yiijI very short distances. If a well-screened house contains many specimens of A.
a : s gyflit is almost certain that breeding is taking place within the house itself. This
S" es bt..s costly by day, :particularly in the afternoon, and is very annoying.
::pantinud efforts to maintain a low A. aegypti index are made by the Health
!i?"t. z t iin. the towns of. the Zone and in the cities of Panama and Colon. These
i:e:itos arwe t .as energetic as would be the case if yellow fever were an imminent
:i.yxSr., but are sufficient.to reduce the number of houses in.which any breeding can
I&..: t:h ae ~rno us annual ifeporte, this chart showed a death rate of .09 for 1923, representing
death ,1 emlploye. Upon recent investigation it is revealed that this was an error, the man in
.lceraiate hi rvice.more than two months before his death. After his discharge
S.....ptei.e iet ina the intridot. wHere he contracted his malaria and died.
J ." ::: I"H.:: ;. ., ... ..
,, I "...: .:.,. :. :'.
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I ~i,,:: -.:. .,. : .., .. ..

S* .. ... ...
'. .. .. ...A.. i*
***" i:. -M -s" : ."*::. i i B
be found topless than one per tcent rFta-itl kt i a.aiit*o
both Panama and Colon. Where breeding ccvrrei i t t ip
vases or other small containers. It. has been. estimated 1by.oert

and under some conditions VV" to & sug: .: 4:~.~
ters for the development of an.epidemic if case e l. er .rit
a town and neglected as regards sanitary pre iuth '.
In view of the scarcity of yellow fever-carrying- ntmgg 4iS IA t he I'f. ii
.the practical disappearance of the disease in the WeWil.n -"Ie isc:r
vigorous maritime' quarantine maintained by The Panias Canal .ttIeat
ment, it is felt that a rec-udescence of this scourge on the Isthllt.u : i
virtually impossible. -. :..::' : ..
(c) Mosquitoes which cause annoyance only. In additionri6 those mentid i
there are many genera and species of mosquitoes which canuasannoys I.
bites but which are not known to convey disease, except that one specfie
more) transmits filariasis, a disease which has never been a factor of ....
the Isthmus. One of the most troublesome mosquitoes in this group 6i th4i
taeniorhynchus, which breeds to a limited extent in bracdish swamps adi. ~i.: i
pools among rocks but develops most prolifically in the deep craecs w .te l.f.
on hydraulic fills during the dry season and become water, containers .itli
rains. This insect can fly for many miles, perhaps as much as 30 or 40. The eSrd'
of annoying mosquitoes is of somesanitary importance here, partly. beca. th
actual irritation they may cuise add partly with a. view to the morale of the .pthlam
public which now considers sanitation neglected whenever any mosquitoes. aP st.,
Until recently much annoyance has been caused in Balboa and Amon d .*Y4b
first part of each wet season by A. taesiorhynckus moequitoe9*hic briedA hj ii i
numbers on the San Juan fill, west of. the Canal; By rearranging..the sch eei0q
the dredging division so that mud could be pumped onto the filled area just
the rains began, this nuisance was almost entirely abated in 192S and.. again ~ni'4
Fortunately it is not necessary to eliminate the last disease
mosquito, or the last human carrier of mosquito-borne patrsr' ujS
order to prevent or practically prevent the spread of mnipp
diseases. Out of each 100 anopheles mosquitoes,, if malaria i. rel4 t
scarce, only a few will have a chance to bite a patient during tlie 44i.
in which his blood contains malarial parasites in the effect
Of those which do so bite, only a limited number will he the :12.'ii
necessary for the malarial organism to reach its full devel 'pen.
insect, and of these some may die before they have an oppoflrt
bite a susceptible person. The same principles apply wjtlh.g sti.
force to yellow fever. Consequently, as regards the epidemic
disease, there are interrelated critical points' in t1the lumber 5hi.i47
quitoes susceptible to infection with the parasite iin quesdao
the number of human carriers of that parasite. Bot. bactoR..
rise above those critical points if there is to be an epi5efii U! fl
number of both susceptible mosquitoes and infected persons
these critical points, then sporadic new cases eof the disease w
in decreasing numbers as one or both factors are still further b ..

.. ........ :.. :. ....: .. ,
,,
9. '-4; :.- ;;: St

M .. .. .. ... ...

ii~| elinaieationUf anopheles mosquitoes in the
tDe~ of s ad window is-les necessary than
d' o actually aes few screened houses in the cities of
ni v l in the pt suburb of the former city. It is not
-si Wr eher we dould do away with screening on the
witut having a rise in the incidence of malaria. At any
-.iaaay collateral comforts such as the exclusion of
.ati. 'ied ~a scorpions, tarantulas, reptiles, etc.
i te;~ts -have sometimes been made to the effect that
~~ie been eradicated from the CanafZone. These statements
us To free the entire Canal Zone from malaria would
p" i 4. of eSfirt backed by millions of dollars. No attempt has
gR^cl i..de to d. Wfis. -As compared with yellow fever, malaria
p .i.*tl .offers a far more-difficult and expensive problem to the
ai frthe following reasons: First, the anopheles mosquitoes
ilaPre rural breeders,. developing in swamps, brooks, ponds,
i U!ijes.e very great areas, and often flying considerable dis-
'i, a. mile or more, to obtain the blood meal necessary for the
^gatior of theirspecies Second, the indigenouspopulation of the
hUts oataiie of the sanitated towns, is-to a large extent chronically
p4 with latent malaria, thereby affording abundant opportunity
iuhtlyi:hatched xasquitoes.to acquire the parasites when they bite
a4detted individuals. The policy adopted in 1922 of permitting
W4i mostin negroes, to settle on the vacant lands of the Zone
i',Wiirasd the opportunities for infection of mosquitoes. Third,
sil Whentract malaria may remain infective indefinitely even when
ualy tireatid with quinine for lengthy periods, and they can not
ii~istL~t spin a screened room as is the rule with the yellow fever
iit.ing :h*is brief 3 days of ihfectivity. Fourth, one attack of
I 'cO fesfrr no immunity to subsequent attacks. Fifth, there is an
i t dPt esira amtng many persons to leave the sanitated areas at
~~~die nid C i other purposes and this desire has been stimulated
bi.'tielst few year by the extension of good roads outside the

#itle.:. to stibj in the program of expanding and improving the
sij tyhi'iE~oqaito breeding is controlled, just when the expense
nli. .lkE n ot b tifed by the gain in malarial prevention
it~~Haid te reduction of upkeep costs-these ques-
|i s:W v2.M ^ Thework is still progressing, but the malaria
.;f' io 'the Canal is not now correspondingly de-
jti y 'tthe ict that an indeterminate but consider-
...M g .f e a which develop among those living in sani-

... :..... : :.. ..... ... : :: I : .... .... ....

tated towns actually acquire their infection when outside the saailtS
ted areas after. sundown. The increasing number of automobiles litt!
the rapid extension of hard-surfaced highways are bound to augWt
this danger each year. Military.maneuvers and mapping expedite
are important factors in raising the rate in the Army, in spite of.l W ,.i
phylactic doses of quinine. An incident taking place in .3925:$( '
a good indication of what would happen if the sanitation of our tOwa;'i:
should be neglected. A gang of workmen; averaging 226 in nufi s
was installing large guns at Bruja Point, which-is located about triar.;>
miles beyond our sanitattd areas. The white men lived in screen 4
houses and the colored men,. constituting most of the..forcei, ^,
under mosquito nets and presumably took prophylactic doses of-qi .:;qi:
nine. Yet in a period of five months 122 of thedt men suffered ar attack i
of malaria. This area has since been drained by the Army authorities:'
and few cases now occur. That the Isthmian malaria has not lost its
pristine powers is shown by the fact that pernicious types, particularly :
the cerebral and algid forms, not infrequently occur and sorpetimeSb.
result fatally.
Recent new drainage work in and about Panama City.--It should
be remembered that tlie cities of Panama and Colon, although not.in.
the Canal Zone, were placed by treaty under the complete sanitary .':
control of the Health Department of The Panama Canal. Their satm-.
tation is paid for by The Panama Canal, except as regards street.:
cleaning and garbage handling, for which the Republic of Panama
pays approximately half the cost. Sanitary control in each of these
cities is effected through the agency of a full-time 'health officer wh6 Ip':,
an American physician employed by and acting under the immediate.
jurisdiction of the Chief Health Officer of The Panama Canal.
UntiL recently the mosquito control measures carried out by .h.-:e
Health Department in and around the city of Panama had not been:..
consistently applied for a distance greater than half a mile from the
borders of town, indeed hardly that far from the outer parts of.the new.::
suburb of Bella Vista. Practically no permanent work had been d one,:,
by the Health Department, even in the large vacant areas local .4,
within the built-up sections of the city, control being effected by rmn-:
lined open earth ditches and by oiling. .
In October, 1924, a new policy was adopted. (See Report for yea:.l;
1924, p. 13). The area of control was promptly extended to a distanKir.
of at least a mile from the city borders, including in those borders a e'
most easterly houses in Bella Vista. (See map No. 1.) Furthermdr
immediate steps were taken to replace all trained streams and unlinei:

S. .

a .-

-1W

. ... .... .N

LIMON ..

S0 ,

E E PANAMA CANAL
DEVELOPMENT OF ANrrTATIO
ATL4.nc TNRINUS

MAP Now L,

I

h-

' .. .. '. "a

narfth ditches by subsoil tile or by concrete bottomed open drains
bhe subsoil method was unsuitable owing to lack of grade or other
t~tn tnces. With the amount of funds which could be made
S.s a able by the Health Department during the last two years it has
ek possible to push the program rapidly. By June 30, 1926, not
:, 'ly hitd mosquito control been entirely effected over the enlarged
:,esbutall open earth ditches within the city, as well as most-of those in
S duridounding area, had been replaced by permanent drainage, and
WS ,s were developed for further extension, particularly eastward along .,
he, Sabanas road toward the Golf Club. These improvements in and
a .bout P-anama have been accomplished by the installation of 12a
miles of ubsoil tile drainage, 2t miles of open concrete bottom drains,
nd 1 miles of new open earth ditch not yet tiled, the total cost being
V, 987.1 The first result of these changes is an increased degree of
protection from anopheles mosquitoes--particularly in and about
ali'donla, Bella Vista, and the Exposition Grounds. The second result
Siiila be a saving in upkeep sufficient to pay for these permanent im-
Srovements in a few years; or, if the same amount of money is
expended annually, it can be largely devoted to further extension of
Spernianebut work rather than used up solely in current maintenance.
Recent new drainage work ien the Canal Zone.-Permanent drainage
wdrk in the Canal Zone has been speeded up during the 'last year,
rtculary at the Pacific end in the o area between Paraison and Ancon
Large installations of subsoil tile or concrete bottomed drain have been
8de west of the Canal near the Pedro Miguel and Miraflores Locks,
oth of Paraiso, in and about Coroal, along the west side of the Cor-
inxduRiver, and on the hydraulic fill between Balboa Heights and
Corozal.e Most of this permanent work replaced temporary earth
wrk i n thesh Cach had been inexistencea considerable time. During the last
L:years a total of 4 miles of tile and 2 miles of concrete bottomed

drain has been placed, and several areas of considerable size have been
filled,'at a total cost of $18,982.86.' The high cost per mile, as com-
Spared with the 6ost of the work referred to in the preceding paragraph,
Sis due to three factors: First, there was a much larger proportion of
S.concrete bottomed open drain, this being far more expensive to install
!than subsoil tile; second, the.work entailed more than the average
Amount of excavation; and, third, a large part of the sectional bottom
il wa placed in very difficult swampy sites where it had to be underlaid
i:, boards in order to maintain grade.
T. his work.was done during the period from Jan. 1, 1925, to June 30, 1926.
-.This work was done during the period from July 1. 1924, to June 30, 1926.
MR 2343--2
I : : : :' .. .
ai"
';I~.

*..

As a result pf the work done by the Health Department of The
ama Canal, supplemented by the work of ihe Army at "ort
and Camp Corozal, the entire area from one mile northnStof,
down through Culebra, Paraiso, Pedro Miguel, Red TankcFci
ton, Corozal, Balboa, Ancon, Fort'Axador, Panama, and BelatW
to the Pacific Ocean has been sanitated, most of it by ueaus ofi!
manent drainage. This represents-a protected area over 13 dle Ie
and ranging in width between a mimimum of 1 mile at sbme po
and a maximum of 6 miles at its oceanextremity. (See map
On the Atlantic side there has been equal recent activity in eelKte
the areas of sanitation. Nineteen and a half miles of new eatli" '':i
and 21 miles of subsoil ille drainage have been iinstalled during .the I.
two years.' The work has been made as permanent as poesibhI.ct'.i
owing to the character of a large part of the terrain-flat, swampy 1i ;:
only a few inches above sea level-it has been impracticable to ia i
much subsoil tile or concrete bottomed drain except in and arc fi :
Gatun. Seven years ago Gatun and Cristobal-Colon were each '.:'i:
rounded by sanitated zones extending less than 1 mile from thect i:w :0
limits, while an unsanitated region occupied the interveiin.:g .:
miles and bred enormous numbers of anopheles mosquitoes. T..19fi:'
Fort Davis was completed on a swampy site located not far f 1 'il' 7
Gatun. The malaria menace compelled the Army to underta&'atAi:
once an antimosquito program for the protection of the garirfbi\
Then the Health Department of the Canal initiated the plan of :sat"
tating the intervening stretch between Fort Davis and Colon. .. .. -2
work is now nearly completed. (June 30, 1926.) The draii~th
program carried out to the east of Manzanillo Bay by the..HiIt;.
Department and by the Army, primarily for the protection of FoCiII
Randolph, France Field, and Coco Solo Naval Base, has gr~leaSf~ti
improved the mosquito situation in Colon. At present the area iidet?
control to the south and east of Limon Bay is about 11 mites in teigW;,t
and varies in width from 2 to 4 miles. Extensive permanent A"iii
semipermanent drainage works completed by the .Army on the l .. lt;.
Sherman reservation, to the west of Limon Bay, have addedi4 ;.t.i. .;
protection of Colon on that flank. (See map No. 1.). -:.:
In many instances the new work done during the last, two ye.raii.
represents not an actual increase in the controlled area, but a. subsfit :
tion of permanent installation for temporary earth ditches. To ap:rii
ate what has been accomplished on the Isthmus by permanent draq
and by filling is impossible unless one was familiar with the daiii..
before these improvements were undertaken. Great aiosquito-bremei
* This work was done during the period from July 1. 1924, to June.30, 1926. .. 4 .

havelb been limminated for all timrne and have become lawns, gardens,
sii" or- harm!e3s grass and jungle land.
i.?.'::t. andcost of recent permanent work.-In all of the recent subsoil
l!aton -special effort has been made to reduce the chances of ob-
5 M tii o of the tiles by silt or roots. The plan for contemplated work
Sis ..... caefully laid out on profile paper with the aid of a level so as to
i~i : t th:ebewt available grade for the entire system, thereby securing
i- ."m: mt scouring action within the tile for eliminating silt. Wherever
:grae. per-its, tile is put at such a depth that its top is at least 24
inc hI es below the soil surface and the trench to a depth of 24 inches is
iI. :.d with broken rock. Placing the tile at such a distance below the
riaee-reduces the likelihood of grass roots qbstructing the lumen and
Ji .i mentally lowers the ground water level, thereby favoring rapid soil
..drying after rains. Except in rare instances all of the tile now used has
Ian interior diameter of 6 inches and is made of concrete, in sections
.1 foot long.
For several years all- open concrete bottomed drains have been
constructed by the sectional method, using precast sections 21 feet
l ongi of semicylindrical shape, with a channel 14 inches across and with
:.a befl at one end to receivethe plain end of the next section. These
i also.are laid strictly to a predetermined grade.
S. Both tile and sectional bottom are manufactured by the Health
SDepartmeht in its own plant at a cost which has now been reduced to
approximately 4 cents per tile and 50 cents per section. Broken rock
: :for covering tile drains costs $1.25 per cubic yard at the crushing plant.
Tn many instances rock is obtained near the job and broken up with
.. sledges by our own gangs at less cost. Labor is paid 21 cents per hour.
SThe average cost of 112,251 feet of completed permanent work recently
installed, about one-fifth of which was concrete bottomed and four-
Sfifths subsoil tile, has been 51 cents per linear foot. As a rule, tile is
i"uchlt less expensive to install than concrete bottom. Naturally
the depth of excavation necessary and the length of haul for material
Decidedly afftc-t costs so that no definite average can be given which is
Applicable to all projects.
I; ums spent for antimosquito sanitation by the Health Department
.:f fTe .Panama Canal.-In recent times the Health Department of
The Panama Canal has had available annually about $1,400,000 to
:.spen.d on its activities including hospitalization, outside medical
..service, cemeteres, and charities for the Canal Zone, and sanitation
na,. miritirnequarantie 'for the Canal Zone and for the cities of
Panamaand dCoI.-. Of thissum approximately the following amounts

... :

have been spent -each fiscal year for the strictly antimosquito
the Health Department:
119.... .. ....... $140,000 1923........ ... .
9120................ ... 140,000 1924...... ..... ... .i
1921....... ........... 105,000 1925... ................ t
1922................... 80,000 '1926 ......... .... ..
In addition to the sanitary program carried out by- the Health
apartment of The Panama Canal, the United States Army authorities
do a large amount ofantimosquito work at a cost qf appjoximat1'K"
$50,000 annually. This sum is entirely distinct from the funds'of tl,
.Health Department of The Panama Canal and is expended inder tie
direction of the Department Surgeon for the purpose of furnishi*'it
protection to the military stations, many of which were located subse; l:
quently to the Canal towns and beyond the areas sanitated by T. >y
Panama Canal. The money is mainly devoted to work.on the military,,. |
reservations, though some of it is spent on adjacent territory whet
necessary for safeguarding the garrisons. The operations df.the Ar"my:a:
and of the Health Department are coordinated by mutual agreementt
so that there is no conflict and the programs are linked together for
the better development of general protection. A large part of the origi-
nal drainage installations put in by the Army authorities was of.a per'i :
manent character. Their sanitary forces are now engaged in replacing:'
some of the earlier earth ditches with concrete bottomed drains..
Advantages of permanent work.-The increase in Health Departmenti :'"3
antimosquito expenditures during the last 2 years has resulted mainf l..
from the intensive program of permanent drainage work, and a a .s--aw~i,
investment these expenditures will pay dividends either in decrease I
future maintenance charges or in control of a much larger .area at t:i;:.
former figure. With reference to the permanent work recently installed ,;::.:
within and about Panama City, it has been estimated that the saving
from reduced cost of upkeep will easily pay for the improveme nt:
together with interest at 3 per cent on the original cost, in abouts
years; in addition, the area and degree of control during these 5 .
years will be much greater than they formerly were.
Unlined earth ditches require to be frequently cleared of siltm ".i
rapidly growing vegetation. This is a difficult and expensive procet;i .::
Even when clean and kept to grade, unless the grade is steep, tif'
frequently hold some water which, at time of infrequent rains, isr'a
flushed out and often furnishes breeding places unless regularly oile i
Subsoil tile requires no upkeep except an inspection once ot twic :
year, which consists of merely walking along the line to see that
a This has nothing to do with house screening. ".

,~
S *. A .:.

wN'- ,.: ,

rii i '" ... .

21

ie :P.rbstructed anywhere. If the tile- is obstructed, water will be-ap-
trei:: t on the surface. Open concrete bottomed.drain, like the unlined-
't:: t h ditch, requiresto be cleaned of debris and vegetation growing on
i. alnks, but this procedure can be carried out very quickly, and to a
i ~Ige-extent is accomplished by merely dragging along the channel
g:... i tlsoaked mop made of old rope. This "whale," as it is called,
m.. i ves debris and at the same time leaves a film of oil over any
remainingg water. After the installation of subsoil or concrete bottomed
Strain, the probability of complete control in a given area is materially
reasedt

: GENERAL REMARKS ON HEALTH CONDITIONS ON
THE ISTHMUS.

"In considering general health conditions and mortality rates on the
Isthmus, it should be borne in mind that in Panama City 78 per cent
of the population consists of negroes and mestizos, in Colon 85 per
cent, and in the Zone 50 per cent.' The negroes are in large part,
SWest Indians who were brought here during Canal construction days,
:'and their descendents. The negro population is greatly overcrowded in
Panama and Colon, Charts 4, 5, and 6 (pages 9, 10, and 11), show the
death rates in the cities of Panama and Colon, Republic of Panama,
and in the Panama Canal Zone during the years in which these areas
h;:.-ave been under the sanitary control of The Panama Canal. The
housing conditions for the negroes are better in Colon than in Panama,
wf'hich fact probably accounts in part for the more favorable showing
!i i that iity.
h e death rate in Panama City has been reduced from over 65 per
S1,000. ip 1905 (the first year of American sanitary control) to less than
i20 per 1,000 for each of the last 3 years. During the same period the
7 death rate of the city of Colon has fallen from 50, or over, per 1,000
4 t. 12.,6 in 1923, 1518-in 1924, and 12.82 in 1925. The Canal Zone rate
has dropped from a maximum of nearly 50 per 1,000 in 1906 to an
v. average below 8.5 per 1,000 for the past 9 years. It is interesting
I:to. compare the above figures with the death rates in some of our
American cities, particularly the more southerly ones, which are shown
is" :table at top of next page.
S... t e p~pnlatioit the Zone for 1925 includes approximately 27 per cent American (white) employees and their
Sint as itatedrsreas, 39 per ceat negro employees and their families living in sanitated areas, 22 per cent
i d (w )ii) Ihi sant stated area 5 per cent employees u(motly negroes)Jivmg in unsanitated areas, and 7 per
o stl aa theirfamilie (mostly negroe) engaged in farmin in unmanitated areas. This latter clam'
B. beemn i.s Ifst e only Mine 1921 and may be expected to act unfavorably on the morbidity and mortality rates.
O; 3123 whitemploeesiad925, about 450 were female. Most of the white male employees are married and have their
:. aand ehiMe withthheman the one.

The death rate from disease among American (white) employe&ett,
The Panama Canal is shown on page 51. In evaluating these figurel....
one should bear in mind two factors: First, the employees must pass' a:iii'
fairly rigid physical examinatioit before coming to the Isthi i.
SLcnd, many Americans suffering from chronic diseases, or incapav:.;l,:
tate i by reason of old age, return to the United States to die. In ....
of these facts, the four diseases causing the highest number of dsqt il; .
in 1923, 1924, and 1925 among American employees were, all cbros 1,n||
maladies and were, in their order of frequency, as follows: Heartdi"ai;4,
cancer, tuberculosis, and apoplexy. Chart No. S shows that as a. cape i
of death malaria has become an insignificant factor. There have b i '4i
no deaths from this disease among employees of The Panama. .Ca.ma!wii
whether white or black, during the last five years, except 2 in 9Z4 ;::
The diagnosis of typhoid fever and of malaria in the Canal i ~' i3
or in the cities of Panama and Colon is rarely based on clinics e$li^ ..
deace alone. .In the past, however, in many tropical countries th<4j':i
has frequently been confusion between these two diseases. Fol ..ih;;
reason the typhoid fever statistics of the Health Department atoi d:
special interest. It will be observed that typhoid fever has cometolb.: .i
trivial factor in the morbidity and mortality figures, as is shown bJ 1 ;iyii.,
," ... .* : .. ... ..I ,
TYPHOID FEVER IN PANAMA CITY, COLON, AND CANAL ZONE.' z :

CHILD WELFARE WORK.
Stealth centers for children'and infants were maintained during the
Ssartat AsDsn, I3albwo and Pedro Miguel. Under the direction of the
i i nn ,ra, many of the mothers of the Pacific side have taken great
-iifitak in these centers.. Six hundred and seventy-five visits have
u t mdidtn4i by .infants or children to these health centers and the
visiting i urse madi 1,034 calls at the homes.
tbe Cristobal Woman's Club Free Clinie in the City of Colon, is
qpg ated jointly by the Cristobal Woman's Club and the Health
S |ucaxrtmfnt. The Health Officer of Colon is the director and the
is utui Department supplies the nurse in charge. The clinic has con-
t. ii ite work to infant welfare, prenatal, dental, and eye, ear, nose,
an&d throat work. Milk is prepared and feedings for one day are
provMied for approximately 25 babies daily.. The following table gives
m rs number of eases treated during the year:
: e (~. eludes all cases under 5) .... .. ... 9,314
ietl .. .. ................ ... .. .. .. 1,619
U.. s. ........................ .... 227
:, ye, ear, nose, and throat ..... ....... 2,346
eTial annual examination of ll children in the schools of the
:a wia ma de by Panama Canal physicians, assisted by trained.
a n the w white choisel 1,983 children were examined, among
. .... .... .
i ,hom the following defects were found:
ieiiid tekh, .............. 342 Othopedic defects....... .. .. 15

found and efforts were made to have remediable. defects.cred-
.. The visiting nurse made weekly inspections .of the schools i
the Pacific end of the Zone. She also assisted. in the examination i
school children of the City of Panama and in the work of the i
Clinic of the Panama Red Cross.-
VETERINARY INSPECTIONS.
The veterinary force of the Health Department carries out the qiA :
antine inspection of animals entering the Canal Zone or the '.,
of Panama and Colon; the inspection of animals transported by rtail :
across the Isthmus; the ante and post-mortem inspection of: ahnima
slaughtered for food; and the inspection of dairies, dairy herds, .and.:..
milk handling. : ;
Quarantine work in 1925 included the examination of 25,363 cattle:
and 43 horses and mules brought into the Canal Zone, or the cit dfKAEi :
Panama and Colon, from the interior of the Republic df'Panamkta :;
and from other countries. There were 4,102 cattle and 6,3223 hg;,: r
inspected for rail shipment across the Isthmus. At the Colon; Panarmi ;
and Mount Hope abattoirs ante and post-mortem examinations were.
made on 25,995 cattle, of which 30 carcasses were condemned. 'Fift ee .i
of the carcasses were condemned on account of extensive bruises; 4''.4l ::::
septic wounds, 7 on account of septicemia, 3 on account of pndumbi .hi .. .-
2 on account of anthrax, 1 on account of actinomycosis, and 2 beiaus il.*.
of their dying condition upon arrival. :
Regular inspections of dairies were conducted to insure eleailin .eli
and acceptable conditions. In addition to this, samples of'milk iwier:
taken at frequent intervals for bacteriological "examination, as a c *
on careless production. The entire milk supply of the Zone andrA~fth::'
cities of Panama and Colon is pasteurized before being delivered to'E:
consumers.
Of the 23,596 hogs slaughtered, 788 were condemned on accoitmt of:
cycticercosis, 103 on account of cholera, 15 on accountof -pne;umoani .
25 on account of exhaustion, 2 on account of pyemia, 1 on acconiit ..
pyrexia, and 1 on account of emaciatior. ".. .i
During the year the Health Department supervised the disinfeetiaf0 ,
of 19,237 hides which were to be shipped to the United States.:

api: inst all countries of South America, except Colombia, Venezuela,
a" i:dpiDutch and British Guiana. The quarantinL on account of yellow
fe; ve,.which was placed against the ports of El Salvador and the Stamm
Crei ;C k District of British Honduras in 1924, was lifted during the year

It is worthy of note that out of a total of 5,549 vessels inspected,
: only three were detained in quarantine, one for 1 days to complete
1; th. e prescribed six days after leaving a yellow fever port, and two U. S.
Navy ships for one day and three days, respectively, because of the
Presence of acute meningitis aboard.
Vssels given radio pratique ..... .... .... ....... ...... 179
i Vesselsinspected and passed.... .................... .. 3,898
Vessels passed on sworn declarations.............. .......... ..... 1,869
VeIsels detained in quarantine .. ............... ... ...... 3

Immigration operations continued under the division of quarantine
: s. heretofore. Eight hundred and fifty-two persons were deported
and 1310 were detained at the quarantine station on account of the
S immigration laws.

.Administration.-The practice of holding periodic meetings of the
: entire staff, and monthly meetings of the head nurses, has been con-
tinued with beneficial results in efficiency of operation and coordina-
:iton of effort. The Clinic and Journal Club, established last year,
i.a.popiular and vahiabl feature of our hospital work.
ip,, "U

m vt))mmm

Professional services.-Duriing the year 1,443 major 't
and 5,186 minor operations, including intravenous injectio i
phenamine, were performed; 3,960 cases visited the out-patte tsi l
cal department; 330 pregnant women were delivered. There'
3,171 cases treated in the medical out-patient department; 554 adia t
and 433 children were vaccinated. There were 10,989 visits to thetajib 0
ear, nose, and throat out-patient department; 2,147 operatii .w:.h ".
performed and 1,156. refractions donL. There were 3,212 taseaae handlt*d
in the radiographic clinic, for which 7,532 ordinary fimu aof arnaw
sizes and 3,223 dental films were used. During the year 387 out.-piatini: F
and 406 hospital patients were treated in the radio-therapy iij4 i
which is charged with the administration of radium therapy, Xnt "I
therapy and hydro-theiapy; 745 radium therapy treatments, 1,9
X-ray therapy treatments and 7,070 physio-therapy treatmentswe rl
given. A total of 40,338 patients were treated by the physicians. 6f".:
Ancon dispensary which is attached to Ancoh Hospital for administra-i i:,
tive purposes. .
Nonresident patients.-Six hundred and eleven patients tiig:
outside of the Canal Zone and the cities of Colon or Panama, weiiI:.-
treated in Ancon Hospital during the year.
Operating expenses.-The follow ing table gives cost of operatMia.
Ancon Hospital (exclusive of dispensary) for the past three crale nd r ..:.'i
year -4:
-~~~~~~1 ------ ---- -,. ^ ^;
1923. 1924. 1925, ;:

SDoes not include the salaries paid by the War Department to medical officers of the Army detailed for duty
with The Panama Canal, which amounted to approximately 532,300 in 1923, $5DQO in 1924 and 878,600 in 19 :*

COROZAL HOSPITAL, :

(Capacity 450 patients.) i

Capt. G. E. HESNER, Medical Corps, U. S. Army, SuperintendeitCi

Pyrpose.-This institution cares for the Insane of the Caeal tZIEi","
and of the Republic of Panama, being reimbursed for the latter idaA-I

.. ... .. .. .

S.. .... ,: .
:4 ..5- .. .:.

- -.' "q 'L -------------

D... ... 2.

l age"ts by the Republic at the 'fixed rate of 60.75 per day.
i.~ti*casl E for Canal Zone employees disabled by. reason of injuries
i!i OI roni:' disease and.who desire to enter the institution.
N:- :i.' :4al, jeraJmoa.--The layingof a new pipe line from a spring
r:"; g lhi ide was completed and water is now being supplied from
S i iw for the refrigerating machines and for washing down the
.:pi.,Mand terw. This results i considerable reduction of water bills,
k. ia*tionsl were tarn down in Ward "C," eliminating the small
I W II B moa which were poorly ventilated and converting the
I upprF o into a dormitory with full size windows, thereby increasing
SthawJed capacity and greatly improving conditions generally.
PMi have i.been completed for the erection of a modern ward of
i parete co.3truction accommodating 104 female patients. This
S sildipg w s -designed that it may be converted into a hospital
. accommodating both male and female patients in the event that re-
re.wl of the Panamanian patients reduces the population of the
Sa imtiaa6n. Work will begin in May, 1926.
Qe~Wi ds.-The mangosteen trees which were brought during the
prviouPs year from Jamaica are growing sturdily; also the cinnamon
-. a :.a nutmeg trees. A row of imported oaks (Quercus fenestrata) was
pintnad along the roadway to the cemetery
a P. Aiccsu.--The census on December 31, 1925, was 389 as
Scompatred with 375 on the same day of the previous year. The number
,admitted was 153.. There were 110 discharges and 23 deaths. No
S k.ijde or death from violence occurred. Of the total released, 31 (28
Super tet) were recovered, 52 (47 per cent) were improved, and 27 (25
'ft eoat) were unimproved. There were 14 patients transferred to
Ancon Hospital for medical or surgical treatment during the year; 8
::.: o Ithesek e w returned to Corozal, 4 died, 1 was discharged, and 1
tf ist sil in Ancon Hospital at the end of the year. Of the total
a ,r isios, 77. were cases paid for by the Government of Panama,
:.. and the remainder were Canal Zone charity or private pay cases. Of.
t:. e 4.. discharged, 41 were deported.
:. nltenaiepecific treatment was given to patients suffering from
phii'tic psychoses, about 20 per cent of the total population. Four
SIt.unided and samIteen.doses of arphenaamin were administered in-
I tnavenBmuly, and 63 lumbar punctures were performed.
I Du~r ti the, yea, work has been continued in the treatment of
F puetite aurt~yphiAiscasus by the induction of malaria. Twelve patients
w::.. :..ere inoculated with tertian parasites according to the Wagner-
JWI xgIiE"UItI ". allowed, to hi w. from 10 to 12 paroxysms, and then
: tinh with. quttiaif The results were disappointing; only two cases

A21... 7 r.: .. '
R,.: : 1.. .. .
-M&'... .. :. .
AN.i i k:i .:".. :

.

showed improvement mentally and physically, and very little ci
was noted serologically. All of the patients treated-.by this reth'
were well-advanced paretics when admitted to this hospital. 0 "J
to inoculation all had received an intensive course of antis fhilitk_
treatment, somehaving received as many as 25 doses of neosalvarsa .a
Eight cases of epilepsy were recently started on the ketogentic'dWti
treatment. One obstacle encountered in the treatment of epileptI5
in the tropics is their disinclination to eat-a high fat diet. .S
Gratifying results were noted with the use of brewer's yeast as a dail
article of diet in the treatment of patients suffering with pellagra. i
Other patients.-There were on December 31, 30 black and 3 whit' :I
chronic.medial or surgical cases (not insane), as comparedwith9~';
black and 3 white of this class at the beginning of the year. :Ninewee'
admitted, 5 died, 1 was discharged and 2 were repatriated. Thi '".
capable of performing work are encouraged to do so. r,
There were 30 cripples (not insane) in the institution on Decemb~ie..:. I?..
31, the same as at the beginning of the year. Two were admitted dfi .-':f.
ing the year, 1 was discharged, and 1 was transferred to the chronic
ward. All but 5 were employed in some capacity by the institotionh :i
their services being utilized -in the garden, guinea-pig warren, d airy .:,.
piggery, ar cemetery, on the motor truck or teams, and in thestea~drf
plant. The five who are not employed by the hospital are each ?'
assigned a plot of land to cultivate individually and are paid for wihat'f!::,
they produce. Under this plan they are able to earn more than the-y :;;::r
would at a fixed wage and the method encourages industry, giving the.ri"': -.:i:
a greater incentive to apply themselves to their task; their aveag:::;
earnings per month amounted to $51.24, and subsistence was furnisih.~:.
them without charge by the hospital. :
Recreation.-Weekly picture shows and concerts have been codt. !:;
tinued throughout the year. During the dry season, picnics.were:h".i ..t
on Saturday in a grove back of the hospital, where lunch was servedti.-: .
and baseball, handball, and other sports engaged in. '""
Occupational department.-The total receipts from the occupationtt I
ward amounted to $5,919.43, of which $4,295.96 was from the sale'o.;
brooms. All of the brooms are made by the chronic patients (not i :t.,'
sane). Money derived from occupational work is utilized for purechasit>i5':"
material required to continue activities in this department arnd for":;
providing workers with tobacco, candy, or other luxuries. The valtuIe.i
of the produce taken from the patients' garden for hospital consumijp1i 'E -:
tion amounted to $5,380.
Dairy and farm department.-Approximately 50 acres *ave be .N .l
added to the hospital pastures through changes in fetce lines -A trt:ilii:

** ..: .'. ,i .

.... :..:.:. *.:. AN .
:ir : **^ "~ ii:*^ : ;:

--- .I ..:: ..* --. ... ;: .

: .29

'ailIibeen cut along the boundaries, and the pastures cleared ot brush.
tis;planned to have the entire hospital reservation enclosed within a
ipermanent fence during the coming year.
i:: in the dairy barns 100 individual concrete mangers were constructed.
:: iOh: n hundred individual automatic drinking cups for use of cattle were
i! .-:Sceived ,. of which 75 have been installed. During the latter part of the
i yeay 1'3, Costa Rican cows wer9 purchased and added to the herd to
k.-ep iLke those butchered because of advanced age or nonproductiveness.
i: The h rd now consists of 41 Jersey cows and 18 calves; 20 Holstein
Sfg03d'grade) cows and 10 calves; and 2 bulls. There were 45,375 quarts
*1f infilk produced and milk sales during the yearamounted to $14,582.35.
.The. receipts for farm produce aggregated $4,285.54, and for manure
1,003.50. There were 269 pigs and 50 hogs remaining on December
31. .The piggery continues to be an important source of revenue, and
%he gross income from this division of the farm for the year amounted
to $7,054.02.
: COLON HOSPITAL.

(Capacity 80 patients.)

iaj. JOHN WALLACE, Medical Corps, U. S. Army, Superintendent.

Purpose.--Colon Hospital is operated largely as an emergency
hospital and dispensary for the benefit of the Atlantic side of the
S-" thmus.
:* ;?. professional work.-During the year, 199 major and 97 minor opera-
" tions were performed. There were 625 administrations of arsphena-
-mine. Three hundred and four pregnant women were delivered.
STh-e dispensary physicians made 267 house or ship calls and 41,605
adttiets visited the out-patient clinic. The eye, ear, nose, and throat
: lnic-was operated in conjunction with the regular white clinic, there
..-being no physician for assignment to this special clinic exclusively.
'" There-were 221 refractions and 119 operations performed. The X-ray
:j. clinic .wa in operation only about 4 months during the year, due to
Ute .e worn-ouit condition of the equipment. A new portable bedside
Snithas been purchased and is due to arrive in the near future.
S..Repairs and. replacements.-A new obstetrical delivery room was
k c:qn structed for colored patients during the year. Practically all of the
Kit7.: ralfurniture and. equipment has been repaired and painted. A
I :i- set of dishes and adjustable bedside stands were purchased for the
Swit: e feinafe arde. Routine painting and repairs to woodwork have
bee a done as r uied.

The patient population reached a maximum of 100 at one time d
the year 1925. There were 94 patients at the beginning of theyea
12 new cases were admitted, 1 was discharged, and 8 died, leanv&a
total of 97 at the close of the'year. The discharged patient ,a iniegr
26 years of age, born in British Guiana, was returned to the land af..her'
nativity. She had been a patient in tht. Colony for 8 years ,.dwi:;
apparently cured at the time of her departure.
The new well, dug in 1924, has proven capable of supplying lteiij
Colony with pure water throughout the year and has relieved serious ..
deficiency. The stratum of fractured basalt underlying Palo Seco::
is not water-bearing and in previous years efforts to obtain a deep s6tpply:; :
has failed. The new well, was dug 20 feet deep in the outcropping f ~'.".
seepage of a hillside and has supplied what water was actually needed'. -
even through the pastrunusually dry season. ..v
A new infirmary was built this year, at a cost of approximately :
$10,000. It is of concrete and frame construction and contains two. '.
wards accommodating 12 bed patients, a commodious operating roori
and a drug room and dispensary. The basement floor will later i ..'
utilized for offices, commissary, and storerooms.
The old infirmary building has been remodeled into quarterslfio ill
patients. When the new offices and commissary are completed, 'th;;i!
old offices and commissary will also be remodeled as patients' quarter l :.i
By these increases in space it will be possible to relieve the.congepsta f i
which now obtains and, to isolate from positive cases the ciaid ic k
negative patients who are awaiting parole.

BOARD OF HEALTH LABORATORY.
(Operated in connection with Ancon HospitaL).

Dr. L. B. BATES, Chief of Laboratory.

Bacillus typhosus.-Recovered in blood culture from 9 individ i
6 were from shipboard, and 3 from Panama City. 'B. fowltdyj*di'4j.
and B. paratypkhoss B, were not recovered at any time during the yS't..
from blood, stool, or urine.

.:. :.:*.- '

........ .. .'.....:.:;......;...,S,

.'. 'a.:: : .. :', .. ". "
-^'- --- -- ----------

1!:.. 1

: Tyiheid c, airs.--rlOn December 31,.1924, two typhoid carriers were
SviKtdr -eanitary surveillance, H. B. and G. H., both of Panama City.
stsi ool ecinens from H. B. were examined monthly and from G. H.
q' up to September when he left the city. All specimens examined were
positive for B. typhosus. No new carriers were discovered during the
.- year
i Tasil and adenoid examinations.-In August of this year a 6-year
i: tu d of all tonsils and adenoids removed at operation was completed.
S Specialaatt atiori has been given to the incidence of tuberculosis. The
totaltninber of specimens examined in this period was 3,685 of which
.Al per cent showed tuberculous lesions. The greatest incidence was
S in cokared children-of 3 to 6 years of age and 80 per cent of all positives
Were from colored children under 14 years. In the white cases prac-
tically alT positives were between 15 and 34 years of age. Two-thirds
of all specimens from cases suffering with phlyctenular keratocon-
/ jitnctivitis were tuberculous. Cervical adenitis was the next most
.important associated lesion.
,Fatal cases of snake bite poironing.-Two patients suffering from
snake bite died in Ancon Hospital, one on October 31, 1925, and one on
November 25, 1925. From the available records it appears that these
two are the only fatal cases of snake bite on record in Canal Zone
: Hospitals. An autopsy was performed in each case. Below is given
a. "a short synopsis of each case.
Autopsy 7320.-G. B., male, black, 40 years cf age, residence Frijoles, was bitten
Over the upper third of right tibia and over internal malleolus of iight ankle on
: October 29th about 7 a. m., when on the trail on his way to work. He was admitted to
.eacon Hospital, nacenscious October 31st at 11.05 a. m. There was a history of
h.beorrhage from mouth and nose immediately after receiving the bite. He died two
Sand a half hours after admission. At autopsy, in addition to the wounds from the
.fingv, there was found extensive hemorrhage in subcutaneous tissues and fascia of
right leg ard ankle, extensive extravasation of blood in right retroperitoneal region,
hemorrhage inand about the right kidney and ureter, hemorrhages in the intestinal wall,
S terebralad meniageal hemorrhages and blood in the middle ears and mastoid antra.
i.: Autopsy 7343.-W. R., male, black, 55 years of age, residence Frijoles, was bitten
.I. -on the dorsal surface of the left foot by a small snake, on November 23d about 8 a. m.
An incision made at the site of the bite bled persistently. He was admitted to Ancon
S: Hospital. November 24th at 3 p'. m. He complained of pain in the left foot and said
S-hat he had.,been spitting up blood. The wound was still oozing blood. He died
November 25th at 5.45 a. a. At autopsy no gross lesions of importance were found
other than, moderate artedioEclerosis. 'Histological sections of the basal ganglia,
medulla, pons and cord all showed marked degenerative change. in the ganglion- cells
S The snake was-killed in each case. However, efforts to get the snakes
for purposes.of identification met with failure. In the first instance the
i snake was thrown into Gatun Lake because of a local superstition that
Sif a snake that has bitten a person is killed and thrown in to the water

RIF

32

the bite will prove harmless; in the second iiistaxice'the patieniIC;
thL snake in the yard while he went into a hut to dress his woun d a:
when he came out he found that the chickens in the.yard had e
the snake.
Mariahuana.-In conjunction with other branches" of the H
Department, the Police Department and the Plant Introductidn-Gi t
dens at Summit, an inquiry was made as to the identity and local t -
of the plant commonly known on the Isthmus as "Mariahuana."
plant was grown from seeds at Summit and lafer identified as Ca .sa..,!i
sativa L. by Paul C. Standley, Associate Curator of the SmrithsoniliL
Institution. He stated that the terms Cannabis indica and Ctnnab ": 1;,
americana are synonyms of Cannabis sativa. The plant grows wild". V 42"
the Canal Zone and in the Republic of Panama and is found :uithM
widely distributed. Its use for smoking purposes seems to be restriiesd: Q>
almost entirely to soldiers. It was not possible to form any apprWxi,
mate estimate as to what extent it is used by them. Smoking ex peir i
ments were carried out with the leaves and tops of both the wild ';'a::::^
cultivated mariahuana plants. The ordinary pharmacological effect R
of the drug were obtained to a moderate degree but these were n :ot
accompanied with any tendency to mania, violence, or disorderliness : j
The evidence tended to indicate that the drug as used here is not halb:it,:
forming in the generally accepted sense of that term. i
Ethyl Esters from Chaulmoogra Oil.-During the past year theii:i
preparation of the ethyl esters of the fatty acids of chaulmoogra'Q : o. :!
has been continued as in previous years. Attention has been directed 'l::i
to the problem of maintaining the content of free fatty adds in.t:4e2t
finished product at the lowest possible point. Esters have been prt-".
pared with very low free acidity, and such esters have been giv ..
intravenously with much less disagreeable effects than usually fdldois::,
the administration of esters with a relatively high content of. fatit .:i,2 :
acids. The study of the esters and their action is being continue" ....
along the lines indicated by this observation. :
Reports.-During the year approximately 40,000 reports have b- :::
rendered. This does not include duplicates. .

Number of American children born on the Isthmus during the year ........... .. .. 156
Dethe amon American children under I year of age ...... .................. ..... 7
Wnantmartau y rate among American children (number of deaths per 1,000 live births) .... 44.87

S TAam VII.-BIRTHB AND BIRTH RATES IN THE CANAL ZONE AND THE CITIES OF
S, PANAMA AND COLON.

Nonsenreal diseases of the petnlo-urinary system
sad anUnex.-Continued.
Prolapsus uteri ...........................
Lacerations, old or recent, of cervix and perineum
Benign tumors of the female genital organs (ex- .
cept of uterus)...........................
Other diseases of the female genital organs.......
Nonpuerperal diseases of the breast (cancer ex-
cepted)................................

Osteomyelitis ..............................
Periostitis ....................................
Other diseases of the bones (tuberculosis and sinu-
sitis excepted) ..........................
A pkylosia.................. ................
Arthritis....................................
Synovitia. ....... ............................
Other disease of the joints tuberculosiss and
rheumatism excepted)................
Other diseases of the organs of locomotion.......

Malformations.

Congenital hydrocephalus....................
Congenital malformations of the heart...........
Other congenital malformations............'..

otl adMimsions of employees .........................................
Lal number transferred between hospitals and from quarters to hospitals, whose
.adjiions are duplicated in the above figures.........................